An investigation of Pasefika access to the Child and Adolescent Mental Health Service within Counties Manukau District Health Board - the influence of health beliefs and attitudes

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Abstract

Pasefika rates of access to Counties Manukau District Health Board’s (CMDHB) Child and Adolescent Mental Health Services (CAMHS) are below the 3% per annum expectation set by the Ministry of Health. CMDHB established a Pasefika specific CAMHS in 2008, Vaka Toa (VT). Our clinical experience is: self-referral by Pasefika is unusual; often when introducing the service to referred Pasefika young people and their family the family will respond with “our [young person] is not mental”. The questions raised from these experiences are; what are Pasefika beliefs and attitudes in relation to child and adolescent mental health and, how do these beliefs and attitudes influence decisions to access CAMHS. An understanding of these beliefs and attitudes will provide opportunities to apply Public Health activities of organised community effort aimed at the prevention of mental health issues and health promotion as interventions to increase Pasefika access to CAMHS in the CMDHB catchment. Descriptive statistics have been provided by CMDHB Research, Evaluation and Audit of Mental Health Services for Period 1, pre establishment of VT, (1/4/2005 to 31/3/2008) and Period 2, post establishment of VT, (1/4/2009 to 31/3/2012) to mark the context of this research. This piece of qualitative research’s epistemological foundation is Qualitative Description (QD). QD is recognised as the methodology of choice when a straight description of phenomena is sought, in this instance Pasefika health beliefs and attitudes. Interviews were arranged with Pasefika naïve to mental health services (MHS) and past service users. Semi-structured interview schedules were developed; all interviews were digitally recorded, transcribed then subject to Thematic Analysis. Findings indicate that the Pasefika holistic health belief model that clinicians are introduced to as a basis for cultural competence is not readily recognised by Pasefika of the 1.5 and subsequent generations, the term mental health is synonymous with mental illness, and stigma remains a significant barrier to MHS access. In order to increase Pasefika awareness of child and adolescent mental health issues messages need to be in accessible language that describes behaviours and reflects parental concerns in conjunction with the promotion of CAMHS as an everyday aspect of overall health care similar to a GP.